Download Arthritis Research Theme 2012 Report

UNIVERSITY OF OTAGO ARTHRITIS RESEARCH THEME
2012 ANNUAL REPORT
Contents
Directors Introduction ................................................................................................................ 2
Aims of the Arthritis Research Theme ...................................................................................... 3
Core members and associate members ...................................................................................... 4
Press releases ............................................................................................................................. 5
Cross-campus arthritis group ................................................................................................. 5
New fund boosts arthritis research ......................................................................................... 6
Otago early-career researcher’s achievements rewarded ....................................................... 7
Juicy bits .................................................................................................................................... 8
Chicago arthritis conference sheds light on new research ..................................................... 8
Local arthritis research given boost by University of Otago ................................................. 9
Ankylosing spondylitis and Spondyloarthropathy: Cutting edge research in New Zealand.. 9
Leading a ‘healthy lifestyle’? ............................................................................................... 11
Milk, Cherries, Vitamin C and gout – fact or fiction? ......................................................... 14
Meetings agendas ..................................................................................................................... 15
Conference Presentations ......................................................................................................... 19
2012 publications ..................................................................................................................... 19
Theme members highlights of 2012 ........................................................................................ 28
The SUGAR Study ............................................................................................................... 28
Outing Gout Hui ................................................................................................................... 28
Dunedin Patient Update Meeting ......................................................................................... 28
Grants received in 2012 ........................................................................................................... 29
Postgraduate students (completed) .......................................................................................... 29
Current Postgraduate Students ................................................................................................. 29
Student travel Awards .............................................................................................................. 30
Summer students ...................................................................................................................... 31
Arthritis Research Theme Logo ............................................................................................... 32
Arthritis Research Theme 2012 Report
1
Directors Introduction
The Arthritis Research Theme has had a successful first year. Two theme meetings have been
held, both in Dunedin. The first meeting in March was attended by ~30 people including
representatives from Arthritis New Zealand and MP Michael Woodhouse (Parliamentary
Friends of Arthritis). This meeting was used to discuss potential new research projects – five
projects discussed at this meeting were the focus of subsequent grant applications - three HRC
(two through to 2nd round), one UORG (awarded) and one Arthritis New Zealand (Awarded).
The second theme meeting was held in December with ~50 attendees. The theme hosted
Professor Matthew Brown, Director of the University of Queensland, Diamantina Institute,
for this meeting with whom collaboration on two projects is underway. It was pleasing to see
more new people at the second theme meeting. Students have been encouraged to attend and
present at the theme meetings with consistently high quality presentations. Two summer
students have been funded by the theme and have completed their 10 weeks of research
investigation.
The theme website has been developed. As well as hosting information about the theme it has
been used by a current PhD student to host patient educational resources required for their
clinical trial. http://www.otago.ac.nz/christchurch/research/arthritis/.
A close relationship has continued with Arthritis New Zealand with attendance by Arthritis
New Zealand representatives at both theme meetings. Theme members have also provided
articles in the quarterly newsletter “Juice” which is sent to all Arthritis New Zealand
members. Throughout 2012, theme members have continued strong contributions to
international Arthritis research endeavours, publishing more than 90 papers in top
rheumatology and scientific journals.
We look forward to another successful year in 2013.
Lisa Stamp
Arthritis Research Theme 2012 Report
2
Aims of the Arthritis Research Theme
1. To strengthen research into rheumatic diseases within the University of
Otago by encouraging basic, translational, clinical, and epidemiological
research relevant to the range of rheumatic diseases
2. To foster collaborative research between disciplines both within and beyond
the University in order to promote world class research
3. Increase external research funding in the broad field of arthritis.
Environmental
causes of
arthritis
Inflammatory
mechanisms
of arthritis
Genetic risk of
arthritis
Patients
with
Arthritis
Way drugs
work in
arthritis
Improving
treatment of
arthritis
Measuring
outcomes in
arthritis
Arthritis Research Theme 2012 Report
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Core members and associate members
Members
DUNEDIN
Associate
Members
Medicine - Dr Simon Stebbings, Prof John
Highton, Dr Paul Hessian
Psychology - Dr Gareth Treharne
Physiology - Dr Andrew Bahn
Pathology - Dr Sarah Young
Pharmacy - Prof Stephen Duffell, Dan wright
(PhD), Julia Korell (PhD)
Biochemistry - Dr Rebecca Roberts, A/Prof Tony
Merriman
Physiotherapy - Prof David Baxter, A/Prof
Milosavjevic
Dentistry - A/Prof Anita Nolan
CHRISTCHURCH
Medicine- Prof Lisa Stamp, A/Prof Lutz Beckert
CDHB –
Dr Peter
Chapman, Dr
John O’Donnell
Clinical Pharmacology - Prof Murray Barclay
Pathology - Prof Tony Kettle, Prof Vicky Cameron
WELLINGTON
Medicine - Dr Andrew Harrison, A/Prof William
Taylor,
Arthritis NZ;
Malaghan
Institute - Dr
Jacqui Harper ;
Michael
Woodhouse MP
Steering Committee: Assoc Prof Tony Merriman, Dr Paul Hessian, Dr Simon Stebbings,
Prof Murray Barclay, Prof Lisa Stamp, Assoc Prof Will Taylor, Prof John Highton, Dr Gareth
Treharne
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Press releases
Cross-campus arthritis group
Otago Daily Timers Wednesday 14 March 2012
The University of Otago is enhancing its support of arthritis research by establishing a crosscampus body of clinical and academic staff, to improve understanding and treatment of the
rheumatic disease that affects more than half a million New Zealanders.
Dubbed the Arthritis Research Theme, the body of researchers from the university's Dunedin,
Christchurch and Wellington campuses will hold its inaugural meeting in Dunedin tomorrow.
The research initiative formalises existing staff collaborations and seeks to create new ones
between those from a wide range of health disciplines.
It comprises 23 members, nine of whom form a steering committee.
The theme aims to build on Otago's internationally recognised research strengths by
encouraging laboratory and clinical studies into the different forms of arthritis, increasing the
profile of arthritis healthcare and research in New Zealand.
Ultimately, its goal is to improve outcomes for New Zealanders living with painful and
crippling conditions.
Associate Prof Lisa Stamp, a consultant rheumatologist and prominent researcher in the field,
has been appointed director of the research group.
She says it involves a "benchtop to bedside" approach in which researchers can interact closely
with clinicians treating patients, leading to innovative research ideas.
"The key challenges we are tackling include how to better identify people at risk of developing
rheumatic diseases, understanding which patients are likely to have more severe disease and
future disability, and how to tailor treatments to achieve the best outcomes for individuals," she
said.
Researchers will focus on diseases including gout and rheumatoid arthritis, as well as less
common conditions, such as ankylosing spondylitis and scleroderma.
Associate members of the newly formed body include Arthritis New Zealand and
Parliamentary Friends for Arthritis organiser Michael Woodhouse.
Arthritis Research Theme 2012 Report
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New fund boosts arthritis research
Otago Daily Times Sunday 15 April 2012
Jack Thomson
University of Otago research aimed at developing smarter diagnosis
of arthritis has been boosted by the first grant from a new fund
administered by the Otago Medical Research Foundation.
The Jack Thomson Arthritis Fund's inaugural grant, of $34,970, will
support a research project to be undertaken by rheumatologist Prof
John Highton, of the Otago department of medicine, and coinvestigators Dr Paul Hessian, of the Otago physiology department,
and Associate Prof Lisa Stamp, of Otago University's Christchurch
campus.
The late William John "Jack" Thomson was a former Dunedin
chartered accountant and company secretary, who died in 2008, aged 83. Mr Thomson
suffered from debilitating arthritis in his later years. Last year, his estate released a $2 million
bequest establishing the research fund.
John Highton
Prof Highton said Mr Thomson's bequest had meant "a big step
forward" for the foundation and arthritis research.
Gaining the inaugural grant, for research focusing on "Subtypes of
inflammation in Rheumatoid Arthritis", was also "rather special", Prof
Highton added.
Severe rheumatoid arthritis, Prof Highton said, caused sufferers "a lot
of misery" and disability, and was also linked to increased mortality.
Nevertheless considerable progress had been made over the past 15
years, including in earlier diagnosis and improved treatment, Prof
Highton said.
The grant will be used to study the role played in the body by certain inflammatory immune
system molecules in rheumatoid arthritis patients. The Otago researchers will investigate
whether measuring expression of these molecules in the bloodstream and in joints can identify
a subgroup of patients who suffer more severe forms of the disease.
Researchers hoped to identify markers in the blood which were linked to specific subtypes of
rheumatic arthritis seen in joint linings. Progress had often come through a series of slow
"mini-steps" over the years, and it was hoped to develop more specific diagnosis through a
blood test, which could also lead to better-targeted treatment, he said.
"Our ultimate aim is to enable clinicians to accurately predict how the disease will progress in
each patient so that therapies can be individually tailored to minimise joint damage and
disability."
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Otago early-career researcher’s achievements rewarded
Otago Daily Times Friday 20 January 2012
An early-career rheumatology researcher who has already made
significant contributions to improving the treatment of arthritis and
gout is the University of Otago’s latest Rowheath Trust Award and
Carl Smith Medal recipient.
Associate Professor Lisa Stamp, who researches and teaches at the
University of Otago’s Christchurch campus and is a consultant
rheumatologist at Christchurch Hospital, receives the Award and
Medal in recognition of her outstanding research performance as an
early-career staff member at the University.
Deputy Vice-Chancellor (Research and Enterprise) Professor Richard
Blaikie congratulated Associate Professor Stamp, saying that the Award and Medal are a
thoroughly deserved recognition of her impressive achievements at an early stage of her
career as a researcher. “Since joining Otago as a senior lecturer in 2004, Associate Professor
Stamp has forged an outstanding research career while also carrying significant teaching and
clinical workloads,” Professor Blaikie says.
After completing undergraduate medical studies at Otago, Associate Professor Stamp
undertook advanced training in Rheumatology in Christchurch, Auckland and Adelaide. She
subsequently completed her PhD at the University of Adelaide in Australia.
She has published almost 60 papers in high-impact journals, received major awards in her
field and has attracted significant grants from the Health Research Council and other funding
bodies. Associate Professor Stamp’s research interests include how best to tailor drug
treatments for rheumatic conditions such as gout and rheumatoid arthritis for individual
patients and determining the role of the immune system messenger interleukin-17 and other
pro-inflammatory mediators in these diseases.
Her research revealing that the dose of the standard gout drug Allopurinol could be safely
lifted above existing clinical guidelines to effectively cure gout in some patients has had a
significant impact on clinical practice. Another study, showing that measuring blood levels of
the frontline drug Methotrexate in rheumatoid arthritis patients is not useful in telling how
well the disease is being controlled, has also been internationally influential.
Associate Professor Stamp says she is delighted to receive the Award and Medal and that her
research achievements owe much to the support of her colleagues and patients. “It has really
been a team effort that has relied on the excellent work of my clinical and research colleagues
as well as the willingness of patients to give up their time to come and take part in these
studies.”
Associate Professor Stamp will be presented with the Carl Smith Medal at a public lecture she
will present later this year. The Medal and Award are accompanied by a $5000 grant for
personal scholarly development. The Rowheath Trust was established in 1964 by Carl Smith
– whose family lived in the Rowheath area of England – to support the University. Mr Smith
received an honorary doctorate from Otago in 1968.
Arthritis Research Theme 2012 Report
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Juicy bits
Theme members’ contributions to ‘Juice”, now re-named “Joint Support”, the Arthritis NZ
Members News Letter
Chicago arthritis conference sheds light on new research
Associate Professor Tony Merriman from the University of Otago, Dunedin
Arthritis NZ The Juice Member’s Newsletter Issue 42 | March 2012
In early November the premier arthritis conference hosted by the American College of
Rheumatology was held in Chicago. It is a huge conference with many parallel sessions, so I
had to carefully plan the presentations to attend.
I focused on gout sessions and also sessions addressing the increased risk of heart disease in
arthritis. Following are some snippets of latest research.
The importance of omega-3 fatty acids, mostly found in oils such as fish oil and flax oil, in
heart health was a theme. Omega-3’s help lower triglyceride levels, which are a risk factor for
heart disease. We currently have an excess of omega-6 fatty acids in the diet, with a ratio to
omega-3 of 16-20:1.
The ideal ratio is 1-4:1. Omega-6s are converted to prostaglandins which promote
inflammation whereas omega-3’s are converted to chemicals such as resolvins which reduce
inflammation. The results of a clinical study showed that higher amounts of omega-3 (>3 grams,
only available in high potency capsules) have benefits on joint stiffness and inflammation.
A new gout drug in the pipeline was described by Ardea Biosciences. Called lesinurad it
works by specifically targeting a protein called uRAT1 that is involved in maintaining uric
acid in the blood. Lesinurad has shown good promise in Phase 1 and 2 clinical trials. Perhaps,
one day, it might be available in New Zealand.
Finally there were talks that concerned the cause of gout attacks. They were more in the realm
of basic science, which may eventually lead to new treatments for gout. In the presence of
high uric acid levels, crystals form in the joints. These crystals are recognized by the immune
system and the painful gout attack ensues.
An important molecule in this is the ‘inflammasome’, which itself produces molecules
(cytokines) that cause more inflammation. An under-researched area that was highlighted by
one speaker is whether genes that influence the action of the inflammasome may help
determine who gets gout and who doesn’t.
Immune cells called ‘neutrophils’ are the infantry in gout. One particularly interesting talk
described molecules called ‘formylated peptides’ that are able to attract neutrophils better
than cytokines. Perhaps this could be important in diverting neutrophils from gout attacks?
Arthritis Research Theme 2012 Report
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Local arthritis research given boost by University of Otago
Associate Professor Lisa Stamp, Rheumatologist, University of Otago, Christchurch
Arthritis NZ The Juice Member’s Newsletter Issue 42 | March 2012
Medical research is an important and fundamental way to improve treatment for patients with
arthritis.
Consequently it is encouraging that arthritis research was recognized in 2011 by the
University of Otago as a Research Theme; providing formal recognition and support for
outstanding and significant research activity.
This decision is a constructive and practical development for those people with arthritis as it
not only highlights the significant amount of research being done across the university into all
forms of arthritis, but also encourages further clinical research in this area which affects more
than half a million New Zealanders, and millions more around the world.
Doctors treating patients with arthritis face a number of clinical challenges. These include
identifying patients at risk of developing arthritis, determining which people with arthritis are
likely to have more severe disease and future disability, and individualizing treatment and
medication to provide the best options for arthritis patients.
The aims of the Arthritis Research Theme are to strengthen research into arthritis within the
University of Otago by encouraging laboratory and clinical research into the many different
forms of this condition, and to increase the profile of arthritis and arthritis research within
New Zealand.
The members of the Arthritis Research Theme, based in Dunedin, Christchurch and
Wellington, are actively researching solutions to these key challenges. Arthritis New Zealand
is an associate member of the theme, as is National MP Michael Woodhouse.
A number of initiatives will be undertaken over the next three years to advance these aims.
These include Theme meetings twice a year to facilitate discussion and development of new
projects, encouraging students interested in arthritis research, development of a Theme
website, and fostering some patients to become involved in the Theme and promotion of
arthritis research.
Members of the Theme will also be providing articles on research for The Juice magazine on
a regular basis. We look forward to working with Arthritis New Zealand in promoting arthritis
awareness and arthritis research.
Ankylosing spondylitis and Spondyloarthropathy: Cutting
edge research in New Zealand
Dr Simon Stebbings Rheumatologist at Dunedin Hospital and senior
lecturer at Dunedin School of Medicine
Arthritis NZ The Juice Member’s Newsletter Issue 42 | June 2012
Ankylosing spondylitis (AS) is a form of arthritis which affects the
Arthritis Research Theme 2012 Report
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back and neck causing stiffness, pain and loss of movement. AS is actually part of a group of
similar forms of arthritis called the spondyloarthropathies, but as this is pretty hard to say it is
often shortened to SPA!
People who have SPA often experience back pain as well as pain in other joints, such as the
knees and ankles, and may also suffer stomach pains, eye inflammation and psoriasis.
SPA is quite common and affects about 1-3 people in 100. Amongst these, about 1 in 3 people
have a severe arthritis that can affect their ability to work and cause long-term pain and
stiffness, which is often worse at night and may affect their sleep.
One of the most striking features of SPA is that it tends to run in families. This is due to a
strong inherited genetic risk. In particular a single gene has been identified called HLA-B27
and this is routinely tested for in people in whom the diagnosis is suspected.
In the last few years, the University of Otago School of Medicine has had an active research
programme investigating the causes, impact and treatment of SPA. This is now part of the
University’s Arthritis Research Theme. Several studies performed by Otago researchers have
been published internationally. Researchers have investigated the potential role of bacteria,
which live in our intestine. It seems that people with SPA may react to bacteria which live in
the intestine, and this might make the intestine leaky allowing bacteria to stir up joint
inflammation.
Researchers at Otago looked at ways of preventing this leaky gut syndrome by using a
probiotic (a preparation of healthy bacteria similar to yoghurt) to see if this would be an
effective treatment for SPA. This project was funded by a research grant from Arthritis New
Zealand.
Unfortunately the probiotic used did not prove to be helpful, although other researchers in the
USA are interested in the concept and plan to repeat this experiment with different probiotics.
Recently, a multicentre study called the SpondyloArthritis Genetics and the Environment, or
SAGE study, has been developed to study SPA across the whole of New Zealand. The
researchers are hoping to find out how common SPA is in this country, to look at genes that
might be important in this type of arthritis and investigate how the symptoms of SPA affect a
person’s quality of life.
A new questionnaire assessing stomach and bowel symptoms has been developed by the
group and will help to record for the first time if these symptoms are important to SPA
sufferers.
Last year, Arthritis New Zealand ran a television and newspaper campaign (with the support
of a pharmaceutical company, Abbott Laboratories) to highlight the symptoms of ankylosing
spondylitis and SPA.
Preliminary research has shown this was very effective in raising awareness of the condition
and many more referrals were received throughout the country during the campaign. This
shows that there are many people in the community who may not be aware they have SPA or
that effective treatment is available.
Arthritis Research Theme 2012 Report 10
If you are a SPA sufferer and would be interested in taking part in the ongoing research in this
condition, there are research centres based in the Rheumatology Units of the following
hospitals: Dunedin, Timaru, Christchurch, Lower Hutt Hospital Wellington, Waikato Hospital
Hamilton, and Greenlane Clinical Centre Auckland. We are always grateful to people who
help with our research.
Leading a ‘healthy lifestyle’?
How do people with rheumatoid arthritis feel about taking their medications and following
advice on leading a ‘healthy lifestyle’?
By Dr. Gareth J. Treharne, PhD, senior lecturer in psychology and unpaid dog walker,
University of Otago
Arthritis NZ The Joint Support Member’s Newsletter Issue 42 | August 2012
One thing that people with arthritis often comment is that they have become an expert on the
multitude of medications they take, as well as becoming an expert on controlling the various
symptoms of their condition.
Becoming an ‘expert patient’ is a phrase that has its roots in a contrast to a model of the old
school approach to healthcare known as ‘paternalism’ because the patient was essentially
being treated like a child by their parents. In that model, the doctor is seen as the expert who
prescribes the best medicine for the patient who passively receives the prescription and was
seen as a bit naughty if they did not follow the prescription exactly, which is often referred to
by doctors and researchers as ‘non-compliance’ or ‘non-adherence’.
But healthcare is changing its emphasis: we now talk about ‘self- management’ of long-term
conditions, which is particularly fitting for people with arthritis who become ‘expert patients’
as you find ways to adapt to your fluctuating symptoms and any ongoing changes to your
medications.
In this model, the doctor is seen as an advisor who offers treatment options to the patient and
both parties come to a decision together. Perhaps this model has always been happening to
some extent in some circumstances, although it certainly has is limit – you probably wouldn’t
want to hear about treatment options if you’d just broken a limb. But this model of healthcare
has its good points for people with arthritis as long as you and your doctors are on the same
page.
When I carried out research on this issue with British people with rheumatoid arthritis I found
that two thirds of participants agreed with the statement that “During the consultations with
your doctors, it is your process of deciding that is most important” and these people are
referred to as ‘autonomists’ because their answer suggests they want to have autonomy over
their treatment choice.
However, these autonomists reported being less likely to take their anti- rheumatic
medications as prescribed, which is perhaps understandable if they felt they weren’t being
given their desired amount of choice.
Moreover, autonomists had more concerns about their medications, which helps us
Arthritis Research Theme 2012 Report 11
understand their reluctance to take them. It is good to talk through any concerns about your
medications with your doctors as this can be an easy way to open a conversation about your
role in decisions about treatment. The choice of medications to treat arthritis sadly doesn’t
include one with no known side-effects, but your doctors’ expertise allows them to be able to
advise you about which medication might be most suitable for your situation, and if you’re an
autonomist then your doctor will value knowing that you want to have some input into the
treatment decision as they go about advising you.
It is also important to tell your rheumatologist if you stop taking a medication because
communication is key in this new model of healthcare where people with arthritis come to
decisions about treatment together with your doctors as experts together.
Another thing that is linked to your control over your well-being is the elements that form a
‘healthy lifestyle’. We all know a lot about what we could be doing to make our lifestyle that
little bit more healthy, but that doesn’t necessarily mean we always do those things. Living a
healthy lifestyle is increasingly seen as something that doctors are duty-bound to advise about
and therefore following a healthy lifestyle is seen as something you can ‘comply’ with in the
same way as one might ‘comply’ with taking a prescribed medication.
This issue of following a healthy lifestyle is pertinent for people with arthritis given that your
joint problems and your fatigue can put limitations on your ability to be physically active,
particularly when you are in the middle of a flare. And eating the healthy option is never very
easy.
Following a healthy lifestyle is particularly important for people with rheumatoid arthritis
because it has been found that people with rheumatoid arthritis are more likely to experience
heart disease than the average person due in part to these limitations on physical activity.
I know that this link between rheumatoid arthritis and heart disease might be news to some
readers, and it is important to remember that it is an increased chance not a certainty.
You have the power to reduce your chance of heart disease, and your doctors will be keen to
help you do so. I have a passion for this issue because my father died of a heart attack when I
was 10 years old, so I know about the loss that can be experienced but I also empathise that
living a healthy lifestyle isn’t as simple as taking a pill, and so this needs to be addressed
appropriately for people with arthritis by services based on research into your opinions.
I have been part of research led by Dr. Holly John in the UK into the best ways to advise
people with rheumatoid arthritis about heart disease. Here I will present some quotes that
people with rheumatoid arthritis said to us. In this research, the decision about following a
healthy lifestyle was seen as no easy choice. As one 54-year-old female participant put it:
“It’s no good me doing the exercise to help my heart if it’s going to make my arthritis worse
because that’s a vicious circle isn’t it really?”
Fatigue is a common problem for people with rheumatoid arthritis, and although research
shows that being more physically active can usually help reduce your fatigue in the long-run,
it’s not necessarily the case in the short-term: “When we go swimming, I find it great but the
next day I might suffer because I’m absolutely shattered.” (59-year-old male participant).
Arthritis Research Theme 2012 Report 12
When you’ve just been diagnosed with rheumatoid arthritis, it’s probably not the ideal time to
raise the issue of heart disease too: “A little bit later once they’ve actually got used to the idea
they’ve got arthritis and then I wouldn’t say like months or years later, perhaps just a month
or a couple of months later, to bring it in then.” (31-year-old female participant).
And when it is a suitable time for advice about following a healthy lifestyle, our participants
emphasised that they already know what it should ideally involve: “I know what I ought to be
eating and I know what I ought not to be eating, and I know I shouldn’t be smoking, and I
know I ought to be doing half an hour exercise three times a week and I know I ought to be
keeping my weight down and my cholesterol down, and all this kind of thing.” (31-year-old
female participant).
But advice was seen as something that could kick-start a change that you might not make
spontaneously: “That would have to come from somebody telling me – I don’t think I would
actually think I’ll go and join a gym or I think I’ll go and do this.” (51-year-old male
participant).
I joined a gym once. I went once and never again. My
advice is to get a dog if your situation allows. Even
better, find a friend who has a dog that you can borrow on
occasion. I’m lucky enough to be motivated to go for
walks by Jose the dog – who could resist that face?
Being an ‘expert patient’ who can ‘self-manage’ your
arthritis is a lot to do with making choices yourself and
sticking to changes yourself, but self-motivation perhaps
relies on the supportive motivation of those around us and is aided by doctors and other
health professionals who advise us. Don’t be afraid to ask your doctors for information about
services like physiotherapy, local walking groups, dietetics, Quitline (0800 778 778 or
www.quit.org.nz) or Smokestop (www. smokestop.co.nz). Quitting smoking is perhaps the
hardest element of a healthy lifestyle to achieve as it involves avoiding a habitual stress- relief
method on daily basis in contrast to doing a period of physical activity on some days or eating
well on most days.
The latest project that I’m involved in that addresses healthy lifestyles is being led by
Associate Professor Lisa Stamp and being run by PhD student Pip Aimer. We’re looking into
ways to help support people with rheumatoid arthritis quit smoking. The project is co-funded
by the Arthritis New Zealand and Health Research Council with input from Arthritis New
Zealand’s Service Development Manager Dr Natalia Valentino and also Dr Simon Stebbings.
We are currently exploring what kind of help in quitting smoking people with rheumatoid
arthritis want before testing a pilot scheme that we aim to eventually make available across
New Zealand. Piece by piece research will help us understand how to support people with
rheumatoid arthritis in all the elements of living a healthy lifestyle and in taking on the role of
expert patient for all aspects of your condition and treatments.
Arthritis Research Theme 2012 Report 13
Milk, Cherries, Vitamin C and gout – fact or fiction?
Lisa Stamp
Arthritis NZ The Juice Member’s Newsletter Issue 42 | December 2012
Gout is a common and painful form of arthritis caused by a build up of uric acid in the body.
Because many foods are broken down by the body to uric acid, gout has long been associated
with dietary excess, in particular rich food and alcohol. A resurgence in interest in gout over
the last 5-10 years has led to new insights into foods the can contribute to as well as help
protect against gout.
Foods that can trigger gout: The more widely recognised dietary triggers for gout remain
important. These include alcohol, red meat and seafood. Over recent years the role of fructose
has been highlighted. Fructose is a sugar found in fruits and many sugar sweetened fruit
drinks which has recently been associated with the risk of higher uric acid levels and gout.
For patients with gout intake if these foods that can trigger gout should be minimised.
Foods that can protect against gout: Of more interest recently has been recognition of
certain foods or food groups that can protect against gout. The two of most interest are low fat
dairy products and vitamin C.
Low Fat Diary and gout: The Health Professionals Follow-up Study of more than 47 000 men
in the USA reported a 21% reduction in the risk of gout for every additional daily serving of
total dairy products over a 12-year period. This effect was greatest with low fat and skim
milk. Furthermore studies have shown that the higher the low fat dairy intake the lower the
blood uric acid levels. Research undertaken at the University of Auckland by Associate
Professor Nicola Dalbeth has confirmed that consumption of certain low fat dairy products of
a three month period can reduce the number of gout attacks.
Cherries, vitamin C and gout: The beneficial effects of cherries in patients with gout has been
recognised since the 1950’s when Dr. Ludwig Blau reported that cherries could help control
attacks of gout and lowering uric acid levels. A study published this month confirmed the
finding that in patients with gout eating cherries was associated with a reduced risk of gout
attacks. Cherries contain vitamin C - 1 cup of cherries has ~10mg of vitamin C. This vitamin
which can only be obtained through the diet has been suggested to lower blood uric acid
levels and reduce the risk of gout. We have recently undertaken a study in patients with gout
comparing vitamin C 500mg daily and allopurinol, the standard treatment for gout. The
reduction in blood uric acid levels in those who received vitamin C was much less than in
those who received allopurinol. The blood uric acid reduction in those who received vitamin
C was insufficient to have any beneficial effect on the long term management of gout. This
suggests that while cherries may have beneficial effects in patients with gout this is unlikely
to be due to vitamin C.
Further research into the diet and vitamin C is continuing in New Zealand and overseas and
new insights into triggering foods and protective foods will emerge. Patients with gout should
avoid foods they know trigger their gout and consider increasing foods known to be
protective.
Arthritis Research Theme 2012 Report 14
Meetings agendas
Thursday March 15th 2012 1000 – 1500, Executive Residence Dunedin
Time
Item
Speaker
1000-1005
Welcome
Mark Brunton
1005-1015
Introductions and aims - Building towards an HRC
programme grant
Lisa
Stamp/John
Highton
1020-1040
Extension of the dirty-dish hypothesis, proposal for a trial of Will Taylor
very early urate-lowering therapy
1040-1100
Individualizing Drug Treatment in Arthritis
Murray Barclay
PhD Student Presentations Chair: Julia Korell
1100-1110
Investigating the role of metabolic trait and serum urate
influencing PDZK1 variants on Gout susceptibility in new
Zealand Pacific Island and Caucasian case control sample
set.
Sara Altaf
1110-1120
Pharmacokinetics of methotrexate in red blood cells
Julia Korell
1120-1130
Identifying and overcoming Barriers to Smoking Cessation
in RA
Pip Aimer
1130-1140
Yoga as a biopsychosocial intervention for the symptom
management of musculoskeletal conditions
Lesley Ward
1140-1150
Profiling purine metabolites
Jacquie Harper
1150-1200
Parliamentary Friends of Arthritis
Michael
Woodhouse
1200-1300
LUNCH PROVIDED
Senior Investigator presentations: Chair John Highton
1300-1320
Is there a genetic basis for poor response to allopurinol?
Dan Wright
1320-1340
Longitudinal data collection an AS cohort
Simon
Stebbings
1340-1400
Tissue remodelling in RA: ‘turning the worm’
Paul Hessian
1400-1415
A successful theme
Rob Walker
1415-1430
The role of Arthritis NZ and the patient in the theme
Sandra Kirby
1430-1450
Research At the University
Dr Katharina
Ruckstuhl,
1450-1500
Closing remarks
John/Lisa
Arthritis Research Theme 2012 Report 15
Meeting attendees (March 2012)
University of Otago, Christchurch Medicine
Janine Francis, Jill Drake, Lisa Stamp,
Murray Barclay, Peter Chapman, Pip
Aimer, Tony Kettle
University of Otago, Dunedin
Medicine
John Highton, Paul Hessian, Simon
Stebbings, Debra McNamarra, Rob
Walker
Physiology
Andrew Bahn
Dentistry
Anita Nolan
Biochemistry
Tony Merriman, Sara Atlaf
Pharmacy
Dan Wright, Julia Korell, Steve Duffull
Physiotherapy
David Baxter, Stephen Milosavljevic
Psychology
Gareth Treharne, Lesley Ward
Orthopaedics
Haxby Abbott
Medicine
Will Taylor, Rebecca Grainger
University of Otago, Wellington
Malaghan Institute Wellington
Jacqui Harper
Parliamentary Friends of Artrhitis
Michael Woodhouse
Arthritis NZ
Alan Henwood, Natalia Valentino,
Sandra Kirby
Arthritis Research Theme 2012 Report 16
Thursday December 13th 2012 1000 – 1600, Large Meeting Room, Dunedin Stadium
Time
Item
Speaker
0930-1000
Arrival; morning tea and coffee
1000-1005
Welcome
Lisa Stamp
1005-1050
Ankylosing Spondylitis
Matthew
Brown
Student presentations Chair: Lesley Ward
1050-1110
Smoking cessation and rheumatoid arthritis
Pip Aimer
1110-1120
Yoga for rheumatoid arthritis: A pilot randomised controlled
trial
Lesley Ward
1120-1130
The effect of uric acid and urate-lowering therapy on innate
immunity
Rene
Maclaughlin
1130-1140
Prevalence of fructose malabsorption in patients with gout
Caitlin Glue
1140-1150
Type IV Hyperlipoproteinemia: A link to gout and
hyperuricemia
Humaira
Rasheed
1150-1200
Living with dry mouth - Sjögren’s syndrome (SS) patients’
perspectives
Joanna Ngo
1200-1300
Lunch (provided)
Senior investigator presentations: Chair: Andrew Harrison
1300-1320
Prevalence of HLA-B27 in the New Zealand population
Rebecca
Roberts
1320-1340
The Arthritis Genomics Recruitment Initiative in Australasia
(AGRIA): genome-wide scan in giant cell arteritis
Tony Merriman
1340-1400
Association between periodontal disease and quality of life
and disease activity in patients with ankylosing spondylitis
Simon
Stebbings
1400-1420
Towards an understanding of increasing adherence to
exercise in osteoarthritis of the knee – an integrative review
Rebecca
Grainger
1420-1440
Compensatory changes and influence of footwear during stair
ascent and decent following knee injury: a knee osteoarthritis
perspective
Gisela Sole
1440-1500
Non-surgical management of musculoskeletal disorders
Haxby Abbott
1500-1520
Matrixmetalloproteinases and macrophages: evidence for a
genetic association in rheumatoid arthritis.
Paul Hessian
1520-1525
Close of meeting
John Highton
1900
Dinner – Plato: 2 Birch St, Dunedin
Arthritis Research Theme 2012 Report 17
Guest Speaker: Professor Matthew Brown
Professor Matt Brown is a clinician-scientist who trained initially in
medicine and rheumatology in Sydney, Australia before moving in
1994 to Oxford, England to pursue research in genetics of bone and
joint diseases, particularly ankylosing spondylitis. He was appointed
Professor of Musculoskeletal Sciences at University of Oxford in 2004
and was Deputy Director of the University of Oxford Institute of
Musculoskeletal Sciences from 2003- 2005.
In 2005 Professor Brown returned to Australia, taking a chair of
Immunogenetics at University of Queensland Diamantina Institute in
Brisbane. There he continues to work in genetics of common
diseases, as well as running a specialist service for spondyloarthritis
patients at Princess Alexandra Hospital. Professor Brown was appointed Director of The
University of Queensland Diamantina Institute in 2011.
Meeting Attendees (December 2012)
University of Otago,
Christchurch
University of Otago,
Dunedin
Medicine
Medicine
Dentistry
Biochemistry
University of Otago,
Wellington
Malaghan Institute
Wellington
Arthritis NZ
Waikato DHB
Pharmacy
Physiotherapy
Psychology
Pathology
Orthopaedics
Ophthalmology
Medicine
Janine Francis, Jill Drake, Lisa Stamp, Murray
Barclay, Pip Aimer, Caitlin Batt
John Highton, Paul Hessian, Simon Stebbings,
Debra McNamarra, Anna Wiles, Rebecca Roberts,
Mary Wallace
Anita Nolan, Joanna Ngo, Jolin Yang
Tony Merriman, Mansour Zamanpoor, Humaira
Rasheed, Tanya Flynn, Ruth Topless, Vidyaliny
Yugaraja, Murray Cadzow
Dan Wright, Julia Korell,
David Baxter, Gisela Sole, Cathy Chapple
Gareth Treharne, Lesley Ward
Estelle Peyroux
Haxby Abbott
Logan Mitchell
Rebecca Grainger, Andrew Harrison
Jacqui Harper, Rene McLaughlin
Natalia Valentino, Suzanne Croft, Alexe Hewitt,
David Cox, Lynne McMillan
Douglas White
Arthritis Research Theme 2012 Report 18
Conference Presentations
Members from the Arthritis Research Theme were present at and presented at the major local
and international Rheumatology meetings
American College of Rheumatology Annual Scientific Meeting Washington DC November
2012
Australian Rheumatology Association Annual Scientific Meeting, Melbourne, May 2012
Asia Pacific League of Associations of Rheumatology Annual Scientific Meeting September
2012 Jordan
New Zealand Rheumatology Association Annual Scientific Meeting September 2012 Nelson
2012 publications
Adhia, D. B., Bussey, M. D., Cury Ribeiro, D., Tumilty, S., Milosavljevic, S. (2012). Validity
and reliability of palpation-digitization for non-invasive kinematic measurement: A
systematic review. Manual Therapy. Online publication. doi: 10.1016/j.math.2012.06.004
Ahmed, O. H., Claydon, L. S., Ribeiro, D. C., Arumugam, A., Higgs, C., Baxter, G. D.
(2012). Social media for physiotherapy clinics: Considerations in creating a Facebook page.
Physical Therapy Reviews. Online publication. doi: 10.1179/1743288X12Y.0000000039
Aldabe, D., Milosavljevic, S., Bussey, M. D. (2012). Is pregnancy related pelvic girdle pain
associated with altered kinematic, kinetic and motor control of the pelvis? A systematic
review. European Spine Journal. Online publication. doi: 10.1007/s00586-012-2401-1
Aldabe, D., Ribeiro, D. C., Milosavljevic, S., Bussey, M. D. (2012). Pregnancy-related pelvic
girdle pain and its relationship with relaxin levels during pregnancy: A systematic review.
European Spine Journal. Advance online publication. doi: 10.1007/s00586-012-2162-x
Alskär, O., Korell, J., Duffull, S. B. (2012). A pharmacokinetic model for the glycation of
albumin. Journal of Pharmacokinetics & Pharmacodynamics, 39(3), 273-282.
Arumugam, A., Milosavljevic, S., Woodley, S., Sole, G. (2012). Evaluation of changes in
pelvic belt tension during 2 weight-bearing functional tasks. Journal of Manipulative &
Physiological Therapeutics, 35(5), 390-395.
Arumugam, A., Milosavljevic, S., Woodley, S., Sole, G. (2012). Effects of external pelvic
compression on form closure, force closure, and neuromotor control of the lumbopelvic spine:
A systematic review. Manual Therapy, 17(4), 275-284.
Baxter, M. L., Ribeiro, D. C., Milosavljevic, S. (2012). Do orthotics work as an injury
prevention strategy for the military? Physical Therapy Reviews, 17(4), 241-251.
Baxter, G. D., Porter-Armstrong, A. (2012). Special Issue: Promoting physical activity to
enhance quality of life [Editorial]. British Journal of Occupational Therapy, 75(2), 47.
Arthritis Research Theme 2012 Report 19
Bentley, R. W., Keown, D. A., Gearry, R. B., Cameron, V. A., Keenan, J., Roberts, R. L.,
Day, A. S. (2012). Vitamin D receptor polymorphisms in colorectal cancer in New Zealand:
An association study. New Zealand Medical Journal, 125(1356).
Bleakley, C., McDonough, S., Gardner, E., Baxter, G. D., Hopkins, J. T., Davidson, G. W.
(2012). Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after
exercise (Review). Cochrane Database of Systematic Reviews, 2, CD008262. doi:
10.1002/14651858.CD008262.pub2
Bussey, M. D., Milosavljevic, S. (2012). Can innominate motion be used to identify persons
with ankylosing spondylitis? A pilot study. Manual Therapy. Advance online publication. doi:
10.1016/j.math.2012.07.010
Chen-Xu, M., Topless, R., McKinney, C., Merriman, M. E., Phipps-Green, A., Dalbeth N.,
Gow, P. J., Harrison A. A., Highton J., Jones P. B., Nissen M., Smith M. D., van Rij A.,
Jones, G. T., Rodriguez-Rodriguez, L., Fernandez-Gutierrez, B., Teruel, M., Balsa, A.,
Pascual-Salcedo, D., Ortiz, A. M., Gonzalez-Gay, M. A., Steer, S., Maehlen, M., Lie, B.
Wordsworth, B.P., Stamp, L.K., Martin, J., Merriman, T.R. (2012) Replication of
association of the interleukin 23 receptor rs1343151 variant with rheumatoid arthritis in
Caucasian sample sets. Annals of Rheumatic Diseases, 71(1), 155-7.
Chin, P. K. L., Vella-Brincat, J. W. A., Barclay, M. L., Begg, E. J. (2012). Perspective on
dabigatran etexilate dosing: Why not follow standard pharmacological principles? British
Journal of Clinical Pharmacology, 74(5), 734-740.
Cury Ribeiro, D., Aldabe, D., Abbott, J. H., Sole, G., Milosavljevic, S. (2012). Dose—
response relationship between work-related cumulative postural exposure and low back pain:
A systematic review. Annals of Occupational Hygiene, 56(6), 684-696.
Dalbeth, N., Pui, K., Lobo, M., Doyle, A., Jones, P. B., Taylor, W. J., McQueen, F. M.
(2012). Nail disease in psoriatic arthritis: Distal phalangeal bone edema detected by magnetic
resonance imaging predicts development of onycholysis and hyperkeratosis. Journal of
Rheumatology, 39(4), 841-3.
Dalbeth, N, House, M.E., Horne, A., Petrie, K.J., McQueen, F.M., Taylor, W.J. Prescription
and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable
factors associated with targeting serum urate in gout. BMC Musculoskeletal Disorders
2012;13:174. PMCID 22978848.
Debono, R., Topless, R., Markie, D., Black, M. A., Merriman, T. R. (2012). Analysis of the
DISC1 translocation partner (11q14.3) in genetic risk of schizophrenia. Genes, Brain &
Behavior, 11(7), 859-63
Duffull, S. B. (2012). Is the ideal anticoagulant a myth? Expert Review of Clinical
Pharmacology, 5(3), 231-236.
Duffull, S. B., Wright, D. F. B., Al-Sallami, H. S., Zufferey, P. J., Faed, J. M. (2012).
Dabigatran: Rational dose individualisation and monitoring guidance is needed. New Zealand
Medical Journal, 125(1357).
Arthritis Research Theme 2012 Report 20
Eglinton, T. W., Barclay, M. L., Gearry, R. B., Frizelle, F. A. (2012). The spectrum of
perianal Crohn's disease in a population-based cohort. Diseases of the Colon & Rectum, 55(7),
773-777.
Fairbairn, K., May, K., Yang, Y., Balasundar, S., Hefford, C., Abbott, J. H. (2012) Mapping
Patient-Specific Functional Scale (PSFS) items to the International Classification of
Functioning, Disability and Health (ICF). Physical Therapy, 42(1), 30-42.
Foo, L. K., Duffull, S. (2012). Adaptive optimal design for bridging studies with an
application to population pharmacokinetic studies. Pharmaceutical Research, 29(6), 15301543.
Foo, L. K., McGree, J., Duffull, S. (2012). A general method to determine sampling windows
for nonlinear mixed effects models with an application to population pharmacokinetic studies.
Pharmaceutical Statistics, 11(4), 325-333.
Foo, L. K., McGree, J., Eccleston, J., Duffull, S. (2012). Comparison of robust criteria for Doptimal designs. Journal of Biopharmaceutical Statistics, 22(6), 1193-1205.
Gaffo, A. L., Schumacher, H. R., Saag, K. G., Taylor, W. J., Dinnella, J., Outman, R., …
Singh, J. A. (2012). Developing a provisional definition of flare in patients with established
gout. Arthritis & Rheumatism, 64(5), 1508-1517.
Grainger, R., McLaughlin, R. J., Harrison, A. A., Harper, J. L. Hyperuricaemia elevates
circulating CCL2 levels and primes monocyte trafficking in subjects with inter-critical gout.
Rheumatology 2012; doi: 10.1093/rheumatology/kes326
Gulati, A., Isbister, G. K., Duffull, S. B. (2012). Effect of Australian elapid venoms on blood
coagulation: Australian Snakebite Project (ASP-17). Toxicon. 61C:94-104.
Hale, L. A., Mulligan, H. F., Treharne, G. J., Smith, C. M. (2012). The feasibility and shortterm benefits of Blue Prescription: A novel intervention to enable physical activity for people
with multiple sclerosis. Disability & Rehabilitation. Advance online publication. doi:
10.3109/09638288.2012.723787
Hale, L. A., Smith, C., Mulligan, H., Treharne, G. J. (2012). "Tell me what you want, what
you really really want....": Asking people with multiple sclerosis about enhancing their
participation in physical activity. Disability & Rehabilitation. 34(22), 1887-1893.
Hale, L. A., Satherley, J. A., McMillan, N. J., Milosavljevic, S., Hijmans, J. M., & King, M.
J. (2012). Participant perceptions of use of CyWee Z as adjunct to rehabilitation of upper-limb
function following stroke. Journal of Rehabilitation Research & Development, 49(4), 623634.
Harwood, M., Weatherall, M., Talemaitoga, A., Barber, P. A., Gommans, J., Taylor, W.,
McPherson, K., McNaughton, H. (2012). Taking charge after stroke: Promoting self-directed
rehabilitation to improve quality of life: A randomized controlled trial. Clinical
Rehabilitation, 26(6), 493-501.
Harwood, M., Weatherall, M., Talemaitoga, A., Barber, P. A., Gommans, J., Taylor, W.,
McPherson, K., McNaughton, H. (2012). An assessment of the Hua Oranga outcome
Arthritis Research Theme 2012 Report 21
instrument and comparison to other outcome measures in an intervention study with Maori
and Pacific people following stroke. New Zealand Medical Journal, 125(1364).
Hatah, E., Braund, R., Duffull, S., Tordoff, J. (2012). General practitioners' perceptions of
pharmacists' new services in New Zealand. International Journal of Clinical Pharmacy,
34(2), 364-373.
Hazlett, J., Stamp, L. K., Merriman, T. R., Highton, J., Hessian, P.A. (2012) IL-23R
rs11209026 polymorphism modulates IL-17A expression in patients with rheumatoid arthritis.
Genes and Immunity. 13(3):282-7
Hefford, C., Abbott, J. H., Arnold, R., Baxter, G. D. (2012). The patient-specific functional
scale: Validity, reliability, and responsiveness in patients with upper extremity
musculoskeletal problems. Journal of Orthopaedic & Sports Physical Therapy, 42(2), 56-65.
Hendrick, P., Mani, R., Bishop, A., Milosavljevic, S., Schneiders, A. G. (2012). Therapist
knowledge, adherence and use of low back pain guidelines to inform clinical decisions: A
national survey of manipulative and sports physiotherapists in New Zealand. Manual
Therapy. Advance online publication. doi: 10.1016/j.math.2012.09.002
Hollis-Moffatt, J. E., Phipps-Green, A. J., Chapman, B., Jones, G. T., van Rij, A., Gow, P. J.,
Harrison, A. A., Highton, J., … Stamp, L. K., … Merriman, T. R. (2012). The renal urate
transporter SLC17A1 locus: Confirmation of association with gout. Arthritis Research &
Therapy, 14(2), R92.
Horn K. K., Jennings S, Richardson G, van Vliet D.V., Hefford C, Abbott J. H. (2012). The
Patient-Specific Functional Scale: psychometrics, clinimetrics and application as a clinical
outcome measure. Journal of Orthopaedic & Sports Physical Therapy, 42(1), 30-42.
Hsu, A., Dalbeth, N., Gow, P., Harrison, A., Highton, J., Jones, P. B., Stamp, L. K.,
Merriman, T. R. (2012). No evidence for association of Chr 9p21 variant rs1333049 with
gout in New Zealand case-control sample sets. Rheumatology, 51, 1129-1130.
Jackson, G., Wright, C., Thornley, S., Taylor, W. J., Te Karu, L., Gow, P. J., Winnard, D.
(2012). Potential unmet need for gout diagnosis and treatment: Capture-recapture analysis of a
national administrative dataset. Rheumatology. 51(10):1820-4
Jensen, B. P., Chin, P. K. L., Roberts, R. L., Begg, E. J. (2012). Influence of adult age on the
total and free clearance and protein binding of (R)- and (S)-warfarin. British Journal of
Clinical Pharmacology. 74(5):797-805.
John, H., Hale, E. D., Treharne, G. J., Carroll, D., Kitas, G. D. (2013). A randomised
controlled trial of a cognitive behavioural patient education intervention versus a traditional
information leaflet to address the cardiovascular aspects of rheumatoid disease.
Rheumatology, 52(1), 81-90. doi:10.1093/rheumatology/kes237
Jostins, L., Ripke, S., Weersma, R. K., Duerr, R. H., McGovern, D. P. B., Hui, K. Y., …
Gearry, R., … and also Barclay, M., Roberts, R. (2012). Host-microbe interactions have
shaped the genetic architecture of inflammatory bowel disease. Nature, 491(7422), 119-124.
Arthritis Research Theme 2012 Report 22
Kazantseva, M., Highton, J., Stamp, L. K., Hessian, P. A. (2012). Dendritic cells provide a
potential link between smoking and inflammation in rheumatoid arthritis. Arthritis Research
& Therapy, 14, R208.
Kazantseva, M. G., Hung, N. A., Highton, J., Hessian, P. A. (2012). MMP expression in
rheumatoid inflammation: the rs11568818 polymorphism is associated with MMP7
expression at an extra-articular site. Genes and Immunity. In Press.
Khan, E. A. R., Stamp, L. K., O'Donnell, J. L., Chapman, P. T. (2012). Cardiovascular
morbidity in rheumatoid arthritis patients in North Canterbury, New Zealand 1999–2008.
International Journal of Rheumatic Diseases. Advance online publication. doi: 10.1111/1756185x.12008
Khan, A. R., Chapman, P. T., Stamp, L. K., Wells, J. E., O'Donnell, J. L. (2012).
Wegener's granulomatosis: Treatment and survival characteristics in a high-prevalence
southern hemisphere region. Internal Medicine Journal, 42(4), e23-e26.
Khanna, D., Fitzgerald, J. D., Khanna, P. P., Bae, S., Singh, M. K., Neogi, T., … Taylor,
W., … Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for
management of gout: Part 1: Systematic nonpharmacologic and pharmacologic therapeutic
approaches to hyperuricemia. Arthritis Care & Research, 64(10), 1431-1446.
Khanna, D., Khanna, P. P., Fitzgerald, J. D., Singh, M. K., Bae, S., Neogi, T., … Taylor,
W., … Terkeltaub, R. (2012). 2012 American College of Rheumatology guidelines for
management of gout: Part 2: Therapy and antiinflammatory prophylaxis of acute gouty
arthritis. Arthritis Care & Research, 64(10), 1447-1461.
Lagishetty, C. V., Vajjah, P., Duffull, S. B. (2012). A reduction in between subject variability
is not mandatory for selecting a new covariate. Journal of Pharmacokinetics &
Pharmacodynamics, 39, 383-392.
Lim, S. S, Vos, T, …Grainger, R, Grant, B,… Taylor, W. J… et al . (2013).A comparative
risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor
clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease
Study 2010. Lancet, 380(9859), 2224-60.
Loke, S.-K., Al-Sallami, H. S., Wright, D. F. B., McDonald, J., Jadhav, S., Duffull, S. B.
(2012). Challenges in integrating a complex systems computer simulation in class: An
educational design research. Australasian Journal of Educational Technology, 28(4), 671683.
McGree, J. M., Drovandi, C. C., Thomson, M. H., Eccleston, J. A., Duffull, S. B., Mengersen,
K., … Goggin, T. (2012). Adaptive Bayesian compound designs for dose finding studies.
Journal of Statistical Planning & Inference, 142(6), 1480-1482.
McKinney, C., Broen, J. C. A., Vonk, M. C., Beretta, L., Hesselstrand, R., Hunzelmann,
N., … Merriman, T. R. (2012). Evidence that deletion at FCGR3B is a risk factor for
systemic sclerosis. Genes & Immunity, 13(6), 458-460.
Arthritis Research Theme 2012 Report 23
McKinney, C., Merriman, T. R. (2012). Meta-analysis confirms a role for deletion in
FCGR3B in autoimmune phenotypes. Human Molecular Genetics, 21(10), 2370-2376.
Milosavljevic, S., Mani, R., Ribeiro, D. C., Vasiljev, R., Rehn, B. (2012). Exploring how
anthropometric, vehicle and workplace factors influence whole-body vibration exposures
during on-farm use of a quad bike. International Journal of Industrial Ergonomics, 42(4),
392-396.
Mulligan, H. F., Hale, L. A., Whitehead, L., Baxter, G. D. (2012). Barriers to physical
activity for people with long-term neurological conditions: A review study. Adapted Physical
Activity Quarterly, 29(3), 243-265.
Murray, C. J., Vos T., … Grainger R., Grant B., …Taylor W. J., et al. (2013). Disabilityadjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a
systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859), 2197223.
Nasir, B. F., Griffiths, L., Nasir, A., Roberts, R., Barclay, M., Gearry, R., & Lea, R. A.
(2012). Perianal disease combined with NOD2 genotype predicts need for IBD-related surgery
in Crohn's disease patients from a population-based cohort. Journal of Clinical
Gastroenterology. Advance online publication. doi: 10.1097/MCG.0b013e318258314d
Peplow, P. V., Baxter, G. D. (2012). Electroacupuncture for control of blood glucose in
diabetes: Literature review. Journal of Acupuncture & Meridian Studies, 5(1), 1-10.
Peplow, P. V., Baxter, G. D. (2012). Gene expression and release of growth factors during
delayed wound healing: A review of studies in diabetic animals and possible combined laser
phototherapy and growth factor treatment to enhance healing. Photomedicine & Laser
Surgery, 30(11), 617-636.
Peplow, P. V., Chung, T.-Y., Baxter, G. D. (2012). Photodynamic modulation of wound
healing: A review of human and animal studies. Photomedicine & Laser Surgery, 30(3), 118148.
Pinto, D, Robertson M.C., Hansen P, Abbott J. H. Cost-effectiveness of Non-pharmacologic,
Non-surgical Interventions for Hip and/or Knee Osteoarthritis: Systematic Review. (2012)
Value in Health, 15(1), 1-12.
Raja, R., Chapman, P. T., O'Donnell, J. L., Ipenburg, J., Frampton, C., Hurst, M., Stamp,
L. K. (2012). Comparison of the 2010 American College of Rheumatology/European League
Against Rheumatism and the 1987 American Rheumatism Association classification criteria
for rheumatoid arthritis in an early arthritis cohort in New Zealand. Journal of Rheumatology,
39(11), 2098-103.
Ribeiro D. C., Sole G., Abbott J. H., Milosavljevic S. (2012) Dose-response relationship for
cumulative work postural exposure and low back pain A systematic review. Annals of
Occupational Hygiene, 56(6), 684-96.
Arthritis Research Theme 2012 Report 24
Roberts, R. L., Barclay, M. L. (2012). The current relevance of pharmacogenetics in
immunomodulation treatment for Crohn's disease. Journal of Gastroenterology &
Hepatology, 27(10), 1546-54.
Robinson, P. C., Merriman, T. R., Herbison, P., Highton, J. (2012). Hospital admissions
associated with gout and their co-morbidities in New Zealand and England 1999-2009.
Rheumatology. Advance online publication. doi: 10.1093/rheumatology/kes253
Robinson, P. C., Taylor, W. J., Merriman, T. R. (2012). A systematic review of the
prevalence of gout and hyperuricemia in Australia. Internal Medicine Journal. Advance
online publication. doi: 10.1111/j.1445-5994.2012.02794.x
Saywell, N., Vandal, A. C., Brown, P., Carl Hanger, H., Hale, L., Mudge, S., Milosavljevic,
S., Feigin, V., Taylor, D. (2012). Telerehabilitation to improve outcomes for people with
stroke: Study protocol for a randomised controlled trial. Trials, 13:233. doi: 10.1186/17456215-13-233.
Smith, C. M., Hale, L. A., Mulligan, H. F., Treharne, G. J. (2012). Participant perceptions of
a novel physiotherapy approach ("Blue Prescription") for increasing levels of physical activity
in people with multiple sclerosis: A qualitative study following intervention. Disability &
Rehabilitation. Advance online publication. doi: 10.3109/09638288.2012.723792
Smith, C. M., Read, J. E., Bennie, C., Hale, L. A., Milosavljevic, S. (2012). Can nonimmersive virtual reality improve physical outcomes of rehabilitation? Physical Therapy
Reviews, 17(1), 1-15.
Sole, G., Rose, A., Bennett, T., Jaques, K., Rippon, Z., van der Meer, J. (2012). A student
experience of peer assisted study sessions in physiotherapy. Journal of Peer Learning.
Advance online publication.
Stamp, L. K., Harrison, A., Frampton, C., Corkill, M. M. (2012). Does a joint count
calibration exercise make a difference? Implications for clinical trials and training [Letter to
the editor]. Journal of Rheumatology, 39(4), 877-878.
Stamp, L. K., Barclay, M. L., O'Donnell, J. L., Zhang, M., Drake, J., Frampton, C.,
Chapman, P. T. (2012). Furosemide increases plasma oxypurinol without lowering serum
urate--a complex drug interaction: Implications for clinical practice. Rheumatology, 51(9),
1670-6.
Stamp, L. K., Chapman, P. T. (2012). Gout and organ transplantation. Current
Rheumatology Reports, 14(2), 165-172.
Stamp, L. K., Hazlett, J., Roberts, R. L., Frampton, C., Highton, J., Hessian, P. A. (2012).
Adenosine receptor expression in rheumatoid synovium: A basis for methotrexate action.
Arthritis Research & Therapy, 14, R138.
Stamp, L. K., Khalilova, I., Tarr, J. M., Senthilmohan, R., Turner, R., Haigh, R. C., …
Kettle, A. J. (2012). Myeloperoxidase and oxidative stress in rheumatoid arthritis.
Rheumatology, 51(10), 1796-803.
Arthritis Research Theme 2012 Report 25
Stamp, L. K., Taylor, W. J., Jones, P. B., Dockerty, J. L., Drake, J., Frampton, C., Dalbeth,
N. (2012). Starting dose is a risk factor for allopurinol hypersensitivity syndrome: A proposed
safe starting dose of allopurinol. Arthritis & Rheumatism, 64(8), 2529-36.
Stamp, L. K., Ipenburg, J., Hurst, M., O’Donnell, J. L., Raja, R., Drake, J., Chapman P. T.
(2012) The Christchurch Earthquake – providing a rheumatology service during a natural
disaster. Clinical Rheumatology, 31; 723-25
Stebbings, S., Bagheri, N., Perrie, K., Blyth, P., McDonald, J. (2012). Blended learning and
curriculum renewal across three medical schools: The rheumatology module at the University
of Otago. Australasian Journal of Educational Technology, 28(7), 1176-1189.
Sundborn, G., Jackson, R., Thornley, S., Merriman, T., Metcalf, P. (2012). The ‘Endgame’
for sugar sweetened beverages. Obesity Research & Clinical Practice, 6(Suppl. 1), 62-63.
Taylor, W. J. (2012). Impact of psoriatic arthritis on the patient: Through the lens of the
WHO International Classification of Functioning, Health, and Disability. Current
Rheumatology Reports, 14(4), 369-374.
Taylor, W. J., House, M., Horne, A., McQueen, F. M., Dalbeth, N. (2012). The Work
Instability Scale predicts absenteeism in people with gout and suggests a higher risk for those
in manual occupations. Journal of Clinical Rheumatology, 18(8), 405-410.
Taylor W. J., Brown, M., Levack, W., McPherson, K. M., Reed, K., Dean, S. G., Weatherall,
M. (2012). A pilot cluster randomised controlled trial of structured goal-setting following
stroke. Clinical Rehabilitation, 26, 327-38.
Tulloch, E., Phillips, C., Sole, G., Carman, A., Abbott, J. H. (2012) DMA Clinical Pilates
Directional Bias Assessment: Reliability and Predictive Validity. Journal of Orthopaedic &
Sports Physical Therapy, 42(8), 676-687.
Tumilty, S., McDonough, S., Hurley, D. A., Baxter, G. D. (2012). Clinical effectiveness of
low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles'
tendinopathy: A randomized controlled trial. Archives of Physical Medicine & Rehabilitation,
93(5), 733-739.
Tulloch, E., Phillips, C., Sole, G., Carman, A., Abbott, J. H. (2012). DMA clinical pilates
directional-bias assessment: Reliability and predictive validity. Journal of Orthopaedic &
Sports Physical Therapy, 42(8), 676-687.
Turner, R., Stamp, L. K., Kettle, A. J. (2012). Detection of allantoin in clinical samples
using hydrophilic liquid chromatography with stable isotope dilution negative ion tandem
mass spectrometry [Short communication]. Journal of Chromatography B, 891-892, 85-89.
Van Egmond, R., Chin, P., Zhang, M., Sies, C. W., Barclay, M. L. (2012). High TPMT
enzyme activity does not explain drug resistance due to preferential 6-methylmercaptopurine
production in patients on thiopurine treatment. Alimentary Pharmacology & Therapeutics,
35(10), 1181-1189.
Arthritis Research Theme 2012 Report 26
Vajjah, P., Duffull, S. B. (2012). A generalisation of T-optimality for discriminating between
competing models with an application to pharmacokinetic studies. Pharmaceutical Statistics,
11(6), 503-10.
Ward, L., Stebbings, S., Cherkin, D., Baxter, G. D. (2012). Yoga for functional ability,
pain, and psychosocial outcomes in musculoskeletal conditions: A systematic review and
meta-analysis. Musculoskeletal Care. In Press.
Ward, L., Stebbings, S., Cherkin, D., Baxter, D. (2012). Yoga for musculoskeletal
conditions: A systematic review of intervention protocols. BMC Complementary &
Alternative Medicine, 12 (Suppl. 1), P97.
Ward, L., Stebbings, S., Sherman, K., Cherkin, D., Baxter, D. (2012). Yoga for
musculoskeletal conditions: A Delphi survey to establish international consensus of core
intervention components. BMC Complementary & Alternative Medicine, 12 (Suppl. 1), P407.
Wassinger, C. A., Sole, G., Osborne, H. (2012). The role of experimentally-induced
subacromial pain on shoulder strength and throwing accuracy. Manual Therapy, 17(5), 411415.
Wilsher, M., Voight, L., Milne, D., Teh, M., Good, N., Kolbe, J., … Merriman, T., …
Dalbeth, N. (2012). Prevalence of airway and parenchymal abnormalities in newly diagnosed
rheumatoid arthritis. Respiratory Medicine, 106(10), 1441-6.
Winnard, D., Wright, C., Taylor, W. J., Jackson, G., Te Karu, L., Gow, P. J., … Dalbeth, N.
(2012). National prevalence of gout derived from administrative health data in Aotearoa New
Zealand. Rheumatology, 51(5), 901-909.
Zhang, M., Moore, G. A., Barclay, M. L., Begg, E. J. (2012). A simple HPLC method for
simultaneous determination of three triazole antifungals in human plasma. Antimicrobial
Agents & Chemotherapy. Advance online publication. doi: 10.1128/aac.00768-12
Zhang, M., Moore, G. A., Fernyhough, L. J., Barclay, M. L., Begg, E. J. (2012).
Determination of imatinib and its active metabolite N-desmethyl imatinib in human plasma by
liquid chromatography/tandem mass spectrometry. Analytical & Bioanalytical Chemistry.
Advance online publication. doi: 10.1007/s00216-012-6284-0
Arthritis Research Theme 2012 Report 27
Theme members highlights of 2012
The SUGAR Study
The American College of Rheumatology and European League Against Rheumatism have
supported a project led by Associate Professor Will Taylor to develop new classification
criteria for gout. This work involves data collection from over 20 international clinical
centres, a novel formalised procedure for certifying expertise with monosodium urate crystal
identification in synovial fluid, a systematic review of the diagnostic performance of modern
imaging techniques in gout and a formal assessment of the preferred accuracy trade-offs in
diagnostic performance for different clinical and research contexts. The final results of the
project will be published simultaneously in the two major US and European rheumatology
journals.
Outing Gout Hui
Outing Gout is a series of hui (held approximately annually) with a kaupapa directed to
sharing knowledge about causes and management of gout. Outing Gout 4 was at Reweti
Marae on 1/2 November, with the Marae hosting participants overnight. The hui was
organised between the host iwi (Ngati Whatua in this case) and members of the Maori Gout
Action Group (a group of health professionals from diverse backgrounds with a shared mahi
of lessening the impact of gout in NZ). The lead organiser was Tony Merriman, with strong
support from Arthritis NZ. University of Otago Arthritis theme members who contributed
knowledge were Lisa Stamp and Jacquie Harper.
Dunedin Patient Update Meeting
A significant part of the Arthritis research effort in Dunedin relies on contributions from
patients of their time and samples. Annual meetings are arranged towards the end of each year
that are designed to inform study participants of final outcomes or update progress. In 2012
the update meeting was on November 29th. The results of research studies covering
Osteoarthritis and Green Lipped Mussel extract, Oral disease and Ankylosing
Spondyloarthritis, Smoking and Rheumatoid Arthritis and Scleroderma were presented.
Theme members contributing were Simon Stebings, John Highton and Paul Hessian.
Arthritis Research Theme 2012 Report 28
Grants received in 2012
Highton J, Stamp LK., Hessian PA - Otago Medical Research Foundation (Jack Thomson
Arthritis Fund). Identification of subtypes of Rheumatoid arthritis through joint and serologic
characterisation. $34,970
Stamp LK. - Arthritis New Zealand Response to biologics in patients with rheumatoid arthritis.
$36,606
Stamp LK. and Bhatia M. - Arthritis New Zealand. Hydrogen sulfide and substance P: novel
markers of inflammation in rheumatoid arthritis and gout. $41,469
Taylor WJ. - American College of Rheumatology – European League Against Rheumatism,
Classification Criteria for the Diagnosis of Gout, US$120,000
Taylor WJ. - Arthritis New Zealand, Classification Criteria for the Diagnosis of Gout (NZ
arm), $49,000
Wright DW, Stamp LK, Barclay MB. – University of Otago Research Grants. Towards a
revised dosing strategy for allopurinol in patients with renal impairment. $25,061
Postgraduate students (completed)
PhD
Marina Kazantseva - Smoking, Genes and Inflammation.
Supervisor: Paul Hessian.
Julia Korell - Modelling Red Blood Cell Data.
Supervisors: Steve Duffull and Lisa Stamp
Current Postgraduate Students
Pip Aimer - Identifying and overcoming the barriers to smoking cessation in rheumatoid
arthritis. PhD Supervisors: Lisa Stamp, Gareth Treharne, Vicky Cameron, Simon Stebbings
Sara Altaf - To identify the genetic link between the metabolic diseases, gout and type 2
diabetes. PhD Supervisor: Tony Merriman
Susan Baxter – Walking as an intervention for people with rheumatoid arthritis. PhD
Supervisor: Gareth Treharne
Emily Davidson - Measurement of change in self-identity after traumatic brain injury. PhD
Supervisors: William Levack, William Taylor
Tanya Flynn - Causes of gout; genetic and social understandings. PhD Supervisor: Tony
Merriman
Anna Gosling - Hyperuricaemia in the Pacific: a biological anthropological perspective.
PhD Supervisors: Tony Merriman and Lisa Matisoo-Smith
Matire Harwood - Understanding and Improving Stroke Recovery for Maori and Their
Whanau. PhD Supervisors: William Taylor, Kathryn McPherson, Harry McNaughton,
Papaarangi Reid, Bridget Robson
Arthritis Research Theme 2012 Report 29
Nyugen Hoang – Statistical methods for the analysis of copy number variants. PhD
Supervisors: Tony Merriman and Mik Black
Beth Mayland – Anxiety and outcomes of upper limb injury. PhD Supervisor: Gareth
Treharne
Valerie Milne - Social and geographic barriers to accessing rheumatology services.
University of Otago. PhD Supervisors: Andrew Harrison and Robin Kearns
Shan Pan – Development of a population pharmacokinetic-pharmacodynamic (PKPD) model
for methotrexate and methotrexate polyglutamates in red blood cells. PhD Supervisors: Steve
Duffull and Lisa Stamp
Humaira Rasheed – Relationship of gout with dyslipidemia. PhD Supervisor: Tony
Merriman
Lesley Ward - Yoga for musculoskeletal conditions. PhD Supervisors: David Baxter and
Simon Stebbings
Mansour Zamanpour - Genetic basis for negative relationship between rheumatoid arthritis
and schizophrenia. PhD Supervisor: Tony Merriman
Aimee Chisnall - The role of SLC2A9 variants in hyperuricemia and gout. MSc Supervisor:
Tony Merriman
Roisin Hegarty – Daily fatigue and psychological well-being among people with rheumatoid
arthritis. MSc Supervisor: Gareth Treharne
Kimberley Hughes, 'The Causative relationship between Serum Urate, kidney function and
phenotypic parameters. MSc Supervisor: Tony Merriman
Warren Scott – Beliefs about exercise among men with rheumatoid arthritis. MSc
Supervisor: Gareth Treharne
Caitlin Batt - Prevalence of Fructose Malabsorption in Gout. BMedSci Supervisors: Lisa
Stamp and Richard Gearry
Student travel Awards
The theme supported two students to attend the NZRA meeting to present their research.
PhD Student Allamanda Faatoese presented her work entitled: Hyperuricaemia and gout in
New Zealand rural and urban Māori and non-Māori communities. Co-Authors - Lisa Stamp, J.
Elisabeth Wells, Suzanne Pitama, RN Doughty, G Whalley, AM Richards, and Vicky
Cameron.
Robbie Fyffe (Medical Student) presented his summer student work entitled: Semiquantitative nailfold capillaroscopy: a diagnostic and prognostic tool for assessing patients
presenting with Raynaud's phenomenon. Co-Authors - Simon Stebbings and Sarah Jordan.
Dunedin School of Medicine
Arthritis Research Theme 2012 Report 30
Summer students
Long Title: Long term urate lowering – how sustained is it after discharge from a clinical
trial?
Author: Nicole Coman-Wright
Address: Department of Medicine, University of Otago, Christchurch, P.O. Box 4345,
Christchurch
Sponsor: The University of Otago Arthritis Research Theme
Introduction: Gout is a common form of inflammatory arthritis caused by the crystallisation
of uric acid to monosodium urate (MSU) crystals. This occurs when serum urate (SU) reaches
saturation concentration (> 0.40mmol/l). Sustained reduction of SU below a target of
0.36mmol/l is critical for long term gout treatment. A previous clinical trial looked at the
effects of systematically increasing allopurinol dose above creatinine clearance (CRCL) based
dose to achieve SU target. Patients were seen monthly for 12 months (year 1) and then seen
annually for a further 2 years (year 2 and 3 visits). Between the annual visits, the patient’s
general practitioner (GP) was advised to monitor SU every three months to ensure it remained
below the target of 0.36mmol/l.
Aims: To determine if allopurinol was continued, if reduction in SU was sustained and if
monitoring advice was followed during years 2 and 3.
Methods: In the previous trial standardized data collection was undertaken during all study
visits. Clinical trial data, clinical notes and laboratory databases were reviewed to obtain
required information. Where patients were lost to follow-up available data was collected until
the 3 year time point.
Results: Allopurinol was being used by all 35 patients at year 1, mean dose of 355.71 mg/day
(150-600mg/day). 29/29 patients who completed year 2 visit were taking allopurinol, mean
dose of 353.5 mg/day (150-600mg/day). Four patients had their allopurinol dose changed.
25/26 patients at the year 3 follow up were still receiving allopurinol, mean dose of 358
mg/day (200-600mg/day). Allopurinol had been discontinued in one patient during a hospital
admission due to acute on chronic renal failure and one patient had their dose decreased.
31/35 (88.8%) patients that completed year 1 achieved the target SU concentration of
≤0.36mmol/l, mean SU concentration of 0.32mmol/l (range 0.23-0.67mmol/l). 24/29 (82.8%)
patients that completed year 2 achieved the target SU, mean SU concentration of 0.29mmol/l
(range 0.19-0.43mmol/l). 23/26 (88.5%) patients that completed year 3 maintained the target
SU, mean SU concentration of 0.32mmol/l (range 0.23-0.64mmol/l). Of those patients that
received three annual SU tests 19/28 (67.9%) remained below target for all three tests.
Three monthly testing plus the annual follow up testing meant that patients should have a
minimum of four tests performed each year. During year 2, 7/35 (20%) patients had ≥ 4
biochemistry tests including SU. At year 3, 4/35 (11.4%) patients had ≥ 4 biochemistry tests
including SU.
Conclusion: The majority of patients 25/35 remained on allopurinol. Increasing doses of
allopurinol above CRCL based dose produces long term reduction in SU with 19/28 (67.9%)
of patients remaining below target for three annual SU tests. Advice about monitoring was
followed in very few patients with only 3/35 (8.6%) patients receiving the recommended
monitoring during both years of follow up.
Arthritis Research Theme 2012 Report 31
Arthritis Research Theme Logo
The logo adopted by the Arthritis Research Theme that has been to the forefront of Theme
meetings and outputs during 2012 includes a distinctly “Otago O-shape”, befitting the links
with the University of Otago. In reality it is part of our research endeavours, showing
immunofluuorescence staining of rheumatoid joint synovial tissue for adenosine receptor,
ADORA2B, protein expression by CD31+ endothelial cells lining a blood vessel.
Arthritis Research Theme 2012 Report 32